Management of the draining tympanostomy tube

Infection of the middle ear space resulting in otorrhea is a common and well accepted complication of tympanostomy tube placement. Despite good evidence that the use of topical ear drops alone is both safer and more effective in the treatment of this condition, systemic antibiotic therapy continues to be utilized as first line therapy for many patients. This article reviews the evidence supporting the use of ototopical antibiotic drops alone as initial management for acute post-tympanostomy tube otorrhea. Topical treatment results in up to 90% cure after a 7 day treatment course. Although otorrhea usually ceases in 4 days, a small percentage of patients will fail to have the infection eradicated by ototopicals alone. Failure of delivery of the medication resulting in persistent infection, re-infection, and possibly, biofilms are the main causes of treatment failures. These patients should be considered for systemic therapy with culture and sensitivity-guided antibiotics. If granulation tissue is present in these failures after steroid-containing ototopical therapy, mechanical removal can be considered. Ultimately the tympanostomy tube can be removed, along with an offending biofilm, if present. If the infection persists beyond despite these treatments, it is progressing toward, or has already become, chronic suppurative otitis media and tympanomastoidectomy may be required.